Tuesday, January 15, 2008

Part 2: Obesity and insurance

Part 2 of my local paper's coverage of bariatric surgery starts like this:

If you smoked a pack of cigarettes every day for 20 years, you might develop lung cancer. Most insurers would pay for surgery and other cancer treatments without quibbling over it.

But if you gradually piled on weight, then developed diabetes or other problems from obesity, your health plan likely would not cover weight-loss surgery without a fight.

Shocking, isn't it? A medical condition insurance companies don't cover. (I'm putting aside for the moment the underlying assumptions here: obesity = medical condition/disease, obesity --> diabetes and other diseases, obesity is volitional.) How could this be, you wonder?

Alas, I don't have to wonder. Two years ago I fought with our insurance company--and lost--over its coverage of my daughter's treatments for anorexia. Because anorexia is considered a mental illness, and because our progressive-in-reputation-only state does not have mental health parity, our insurer got away with covering only a small percentage of the cost of my daughter's treatment.

Where were the incredulous newspaper stories then? Where was the hue and cry, the uproar at the injustice?

Uh-huh. I thought so.


Anonymous said...

Unsympathetic insurance companies? NO! I'm shocked. Really. Ours will 'generously' cover less than half after we fork over the $3000 deductable first. Never mind how 'wonderfully helpful' they've been about finding treatment in the first place. But once he's been admitted for cardiac arrhythmia they'll cheerfully foot that one so long as no one mentions anorexia in the diagnosis. How completely heart warming. I feel so secure.

mary said...

There have been a few parents who sought legal aide and used a learning disability to get ins. assistance which is denied to those who don't know about it. It's all part of the rights set up for those with handicaps. Albinism, autism, mentally challenged, ADD, on and on. If there is any way the school can help with this you might have a case you can appeal.It seems that many kids today are given support in some way or another. This is one time when a learning disability can pay off. Unfortunately many parents are sworn to secrecy regarding the support they are given. (much like college...everyone gets a different fee bill) I'm not sure what would happen if they shared out loud "how" they won but because they don't want to spoil it for themselves they keep quiet.
We need a mental health care act that takes care of all of us because it's the right thing to do.
While they're at it I wish they'd address eyes and teeth....the forgotten body parts in health care.
I hope that there is some sort of compensation for all you've paid Harriet. It isn't fair.

Harriet said...

Hell, Mary, at least we didn't end up taking out a second mortgage on our house or using up our meager retirement funds. The whole thing is unfair for everyone.

sad mom, I know what you mean. My daughter landed in the hospital for 5 days for dehydration and malnutrition, and almost all of that admission was covered. But the inpatient e.d. clinic our doctor recommended would have cost more than $50,000. Thank god (for many reasons) we didn't go that route.

Doctors are getting savvier about this stuff. Lots of them are avoiding using the word anorexia in their diagnosis codes, and forcing insurers to cover at least medical admissions. What a joke.

Anonymous said...

My insurance company denied me coverage for inpatient treatment as well. The full story is here. The sad thing is that this is not uncommon - it's the norm.

Someone (I don't remember who) once said, "There's a special place in purgatory for insurance companies." Boy, I sure hope so.

Harriet said...

Charlynn, I know what you mean, unfortunately. I hope you're right about purgatory. Let's make it hell, though.

Anonymous said...

All I can say is, if there were any lung cancer treatments out there that killed between 1% and 2% of patients within the first month (who were not terminal -- and no, "morbid obesity" is NOT terminal either), and had the rates of complications that WLS has, they'd be laughed out of the offices of the FDA. Only fat people are seen as fit to be operated on almost literally like guinea pigs, with little to no regard for their long-term quality of life.

Harriet said...

I hear ya.

We need a civil rights movement for fat people.